My turn for insurance issues: Aetna and labs

harrietvane

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Feb 12, 2016
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774
Location
Singapore
I've had labs the past two years without issue. This last lot, they apparently needed to get a Letter of Guarantee from Aetna before running them, as it's SG$1000. The clinic has told Aetna that it's follow-up from bariatric surgery (which they didn't refer to me first), and they've finally sent it to me to respond to Aetna's questions.

Will be sending the email to my insurance agent and asking him to get my my EOC (I'm a private buyer, not through work, so I assume that's how I access it) and post the relevant bit here.

1. How likely is it that insurers will pay for labs? If they deny this, would they be able to retroactively deny previous labs they've covered?

2. There's a Quest labs here. Is there a way to request labs yourself with Quest?

I can (and will) pay for annual labs as part of the 'deal' that is the DS - it's a small price to pay overall for my health. However, surely being 60kg lighter and no longer on a laundry list of medications is cheaper to Aetna than still being fat and using my insurance for that. Seems like a false economy from the insurer's side.
 
Lots do pay! It may make a huge difference to make sure they are coded as due to malabsorbtion instead of bariatric surgery related. But your EOC will tell the story.
 
Sigh, I fear that option has been blown by the nurses telling the insurer in an email that it was bariatric surgery related. Really wish they'd called me first.
 
Sigh, I fear that option has been blown by the nurses telling the insurer in an email that it was bariatric surgery related. Really wish they'd called me first.

Make them correct it!

They can exclude pre-and immediate post-op stuff. But no one can PROVE that your need for this labwork is directly related to the DS.

It MAY BE related to bariatric surgery...or genetics...or a lousy diet...which may or may not be related to the DS...or antibiotics that killed off good gut stuff.

If you allow them to "blame" the DS for your need for labs, they will later try to blame EVERYTHING on bariatric surgery...AND DENY IT ALL.
 
Sigh, I fear that option has been blown by the nurses telling the insurer in an email that it was bariatric surgery related. Really wish they'd called me first.

It still would be worth a try to have your Dr office resubmit with revised cpt codes such that Aetna reconsider. Good luck!
 

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